This proposal is a first step in a line of research designed to better understand what occurs in busy, urban psychiatric emergency rooms (PERs). Little attention has been paid to the perspectives, attitudes and beliefs of the staff, consumers and other stakeholders involved in PER care, and the influence of these perspectives on the provision of care. This proposal focuses on PER staff. We will describe the work of PER staff and their interactions with patients by asking what PER staff do in the PER. We will describe staff understandings of the influences, particularly those related to the social context and contingencies of their work, on their interactions with patients - How do PER staff think and feel about what they do? We will assess staff attitudes and beliefs about patients who use the PER and the processes by which staff identify or label patients who use the PER. And finally we will explore in a preliminary fashion whether there are differences between patients labeled (either positively or negatively) by staff and other patients and to explore if there are differences in the content and nature of care in the PER received by consumers/patients based on staff identification or labeling. We will draw upon both qualitative and quantitative research methodologies. The proposal is informed by guiding theories which relate to the relationship between workplace characteristics and demands on staff, and staff perspectives on their work and the patients they work with. Labeling theory will help guide our analyses and interpretation of the results related to the potential impact of staff labeling on the process of care in the PER. Data collection methods will include structured observations, in-depth interviews, focus groups and a structured medical chart review with quantitative analyses. These data, which focus on the staff of the PER, will have tremendous implications for the designing of appropriate interventions and services within the PER and ultimately when integrated with research on consumers and other stake holders, to improve the clinical outcomes of people who use the PER. We must increase our understanding of the work of the PER staff, the staffs understanding's of their work, their attitudes about the patients they work with and the way the group patients who use the PER, and the potential impact of the labeling of staff on the process of PER care, if we are to provide psychiatric emergency care in ways that are appropriate for consumers/patients and PER staff.